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CAVE RUN PHARMACY
DSH180018 ST CLAIRE MEDICAL CENTER INC
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Covered Entity Details
Entity Name
ST CLAIRE MEDICAL CENTER INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180018
Entity Address
222 MEDICAL CIRCLE
MOREHEAD, KY 40351
Medicare Provider Number
180018
Participating Start Date
1/1/2005
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
CAVE RUN PHARMACY
Pharmacy Address
255 OLD FLEMINGSBURG RD
MOREHEAD, KY 40351-1090
Pharmacy Comments
1/29/2009 - CHANGED CP INFO FROM ENTITY NAME AND ADDRESS TO CORRECT TYPO.
Contract Details
Approval Date
1/15/2010
Contract Begin Date
1/15/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
G.R. JONES, VP FINANCIAL SERVICES/CFO
(606) 783-6508
Contract Pharmacy Representative
WILLIAM W. SHELY, PRESIDENT
(606) 783-1511
Signed By Date
11/24/2009
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